肩關(guān)節(jié)不穩(wěn)教學(xué)課件

TheEffectsofThermalCapsularShrinkageontheOutcomesofArthroscopicStabilizationforPrimaryAnteriorShoulderInstability*關(guān)節(jié)囊熱攣縮對(duì)關(guān)節(jié)鏡下肩關(guān)節(jié)穩(wěn)定手術(shù)效果的影響*SportsMedicine,HuashanHospital,FudanUniversity,Shanghai,China★SportsMedicine&ShoulderService，StGeorgeHospital,UNSW,Sydney,Australia*ShiyiChen,etal,AJSM33(5),2005ShiyiChen*,GeorgeACMurrell★

BackgroundThepostoperativerecurrenceofshoulderinstability(RSI)isstillrelativehighinArthroscopicShoulderStabilizationcomparedwithopenprocedure.ArthroscopicBankartrepairinvolverepairsofthelabraldetachmentaswellastighteningorenhancingtheglenohumoraljointcapsule.

Theeffectivenessofarthroscopicthermalcapsulorrhaphyinthepreventionofrecurrentinstabilityinprimaryanteriorstabilizationisundetermined.ReportedFailureRateofArthroscopicStabilizationfor

AnteriorShoulderInstabilitywithSuretacTacksAuthors(Year)ArthroscopycasesRe-dislocationcasesFailurerate%plantsFU(M)DeBerardino(2001)49612%Suretac37Dora(2000)37616%Suretac54Karlson(2001)60915%Suretac28Sperber(2001)30723%Suretac13Cole&Warner(2000)37924%Suretac54SistoDJ(1998)23313%Suretac47Speer&Warner(1996)521121%Suretac42ArthroscopicShoulderStabilizationLabrumRepairorrestore

盂唇修復(fù)、重建Sutureanchors（GII，TwinFix）Knotlessanchor（QuickT，Bioknotless）biodegradableimplants(SureTacTissueTack）Capsulorraphy

關(guān)節(jié)囊收縮CapsuleShiftThermalCapsular

ShrinkageResearchObjectiveTocompareifthepatientswithtraumatic,unidirectionalrecurrentanteriorshoulderinstabilitywhohavelabralrepairplusarthroscopiccapsularshrinkagehavebetteroutcomesthanthosewithlabralrepairalone

Patients&MethodsRetrospectivecasedcontrolledcohortclinicalstudy72

patients,anarthroscopicanteriorshoulderstabilizationbythesamesurgeonwithSuretacII?tissuetacksGroupA=32，SuretacII?Tack，1996-1999GroupB=40，

SuretacII?Tack+ArthroscopicShrinkage，1999-2002Pre-&among-operativeevaluation

EUAforshoulderinstabilityBankart

Lesioninallcases*ShiyiChen,etal,AJSM33(5),2005OperativeTechnics

LabrumRepair＋CapsularShrinkage*ShiyiChen,etal,AJSM33(5),2005PatientsDataOfthe72patients,66hadcompletefollow-upincluding28patientstreatedwiththeSuretacstabilizationand38patientswiththeSuretacplusradiofrequencyshrinkage,foranaveragefollow-upof58and30monthsrespectively.72例病人中，有66例得到完全隨訪；A組28例，平均隨訪時(shí)間58個(gè)月，B組38例，平均隨訪30個(gè)月。*ShiyiChen,etal,AJSM33(5),2005VariationGroupAGroupBPvalueNumber2838Sexratio(m:f)M20：F8M26：F12P>0.05Meanageatsurgery(y)25.6(15-44)25.3(15-43)P>0.05Follow-Uptime(M)*58(30-87）30(10-52)P<0.05Timefrominitialtosurgery(M)37(2-204)38(1-240)P>0.05Timesofdislocationpre-op5.5±3.4(2-20)5.9±3.8(2-25)P>0.05AffectedshoulderR13/L15R21/L17P>0.05DominantarmR20/L8R31/L7P>0.05Re-dislocationduringFU(N0.)6/288/38P>0.05InitiatingeventsSports18Caraccident7Workinjury3Sports28Caraccident6Workinjury3Numberoftacksused2.2±0.7(1-4)2.2±0.7(1-4)P>0.05Time,returntowork

(M)SuccessfulcasesFailurecases3.4(2-9)3.8(2-9)3.6(3-6)3.4(2-7)3.8(2-7)2.8(2-4)P>0.05(F=0.004)P>0.05(F=0.100)P>0.05(F=2.017)Time,returntosports

(M)SuccessfulcasesFailurecases3.7(2-7)3.5(2-7)4.0(3-6)4.4(3-10)4.6(3-10)4.2(2-6)P>0.05(F=4.722)P>0.05(F=4.979)P>0.05(F=0.256)9、人的價(jià)值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:36:37PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請(qǐng)。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯(cuò)的事來(lái)懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個(gè)人炫耀什么，說(shuō)明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個(gè)人即使已登上頂峰，也仍要自強(qiáng)不息。2023/2/32023/2/32023/2/32023/2/3ResultsBothgroupswerematched

forsex,age(26versus25years),levelofpre-operativeactivityinworkandsports,timefromfirstinjurytosurgery(37versus38months)andthenumberoftissuetacksused(2.2versus2.2).兩組病例在以下諸方面進(jìn)行配對(duì)性別，年齡（26：25歲），術(shù)前運(yùn)動(dòng)和工作水平分級(jí)，初次損傷到手術(shù)的時(shí)間（37：38個(gè)月），術(shù)中使用的SuretacII?組織鉚釘（2－3枚）PatientsEvaluationStandardizedpatient-determinedandexaminer-determinedoutcomemeasureswereobtainedpre-operativelyandat3,6,12and24monthspost-operatively.StatisticalanalysesincludedaKaplan-Meieranalysisoftimetorecurrentinstability.T-test*ShiyiChen,etal,AJSM33(5),2005ComparisonofWorkandSportsActivitybetweentheTwoGroups

（兩組病人決定因素比較）GroupAGroupBP

valuePre-operativeworkactivity*2.92±0.652.87±0.750.783Post-operativeworkactivity*2.77±0.682.74±0.530.854Pre-operativesportsactivity*2.68±0.482.68±0.530.986Post-operativesportsactivity*

2.61±0.612.54±0.650.709ComparisonofROM,Pre-&Post-operationbetweentheTwoGroups（兩組醫(yī)生決定因素比較）ROM(N±SD)GroupSuretacSuretac+Shrinkage

FF*AB*ER*IR*FF*AB*ER*IR*Pre-operation156±22143±3046±158±3158±24144±2652±199±4Post-op6w138±27132±2932±147±3149±27129±3237±166±312w157±20146±2843±169±2158±24144±3640±199±46m175±9173±945±2311±4166±22163±2858±189±41y165±7170±1447±118±4162±14160±4253±189±32y170±7172±2252±1311±4170±14170±1653±1210±3*FF(Forwardflexion);AB(Abduction);ER(Externalrotation);IR(Internalrotation)gradedaccordingtovertebrallevel:L5andbelowL5=1,L4=2,L3=3,L2=4,L1=5,T12=6…T7=11…TherewerenostatisticaldifferencebetweenthetwogroupswithrespectofFF,AB,ERandIR.ResultsAllpatientshadaBankartlesion.

Bothgroupshadsimilarresultswithrespecttopatient-determinedandexaminer-determinedoutcomemeasures.兩組所有病人均有Bankart損傷；兩組病例在病人決定因素（客觀）和醫(yī)生決定因素（主觀）的療效評(píng)定中結(jié)果相同

ResultsTheonlyadverseoutcomewaspost-operative

re-instability.

TraumaisAMAINRISKFACTOR

sixof28casesintheSuretacgroupaloneeightof38casesinSuretacplusshrinkagegroupMostre-instabilityoccurredbetween6-24months.唯一不良結(jié)果是較高的復(fù)發(fā)性不穩(wěn),

再脫位的主要危險(xiǎn)因素是創(chuàng)傷A組（28）5例再脫位，1例復(fù)發(fā)半脫位B組（38）6例再脫位，2例復(fù)發(fā)性半脫位大部分不穩(wěn)均發(fā)生在術(shù)后6-24個(gè)月之間AnalysisofPossibleRiskFactorsinCaseswithRecurrentInstability

（復(fù)發(fā)性再脫位病例危險(xiǎn)因素分析）SuretacSuretac+ShrinkageNo.ofre-instability/totalNo.6/288/38Sexratio3female,3male8maleAge(years)25(16,19,19,21,32,46)25(17,18,19,21,21,23,27,35)Bankartlesions68Numberoftacksused2,2,2,1,2,22,3,2,2,3,2,2,1Timetofull-work(months)3.62.8Timetosports(months)4.04.2Timetore-instability(m)16(6,9,10,15,24,45)11(5,6,11,12,12,14,21,29)Re-dooperation4opensurgery,2non-surgery4opensurgery,4non-surgeryEventsofre-instability4contactsports,1epilepsy,1atraumaticsubluxation5contactsports,1MVA,2atraumaticre-dislocationRe-subluxation&age1(19years)2(19years,17years)Meantimefollow-up(m)5830Kaplan-Meieranalysisfortimetore-instabilityshowednodifferencesintherateofinstabilityrecurrencebetweentwogroupsDiscussionThemainpathologyinRSI,LabrumTear＋Capsulelaxity

WhichCapsulorraphy?CapsuleShiftThermalCapsularShrinkageWhiledoingLabrumrepair，

itis

necessarytodoCapsulorraphy.WhatistherealfunctionofRFShrinkage?射頻關(guān)節(jié)囊攣縮的作用如何？Levyetal.

56

LZ，34

RFFU：40M，23M

Failure：36％24%JBoneJointSurgBr83(5):640-5,2001Andersonetal，104casesMP-RFFU：1-16M（6）,

Failure：14％

AmJSportsMed30(1):103-7,2002HowlongcantheeffectofRFShrinkageacton?

關(guān)節(jié)囊熱攣縮能持續(xù)多久？McFarlandetal.7

casesRSI，16MFU，Morphology－capsuleattenuationAmJSportsMed30:636-642,2002Wallaceetal.AnimalExperience，RFtreated，ligamentmechanicsdecreased,onlypartialrecoveryafter12wks韌帶力學(xué)性能降低，12周后蠕變性能部分恢復(fù)AmJSportsMed30:98–102,2002

TheroleofRFneedtobefurtherstudy